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Home My WebLink About02-0732PETITION FOR PROBATE and GRANT' OF LETTERS ~-.~tate o> ~'~~~ E ~ACK~P No. 21-OZ-"132 also knotrn as F E'• ~ACKE~P To: Deceased, Socia! Security No. ~7~-O/- a~f/2 Register of Wills for the County of C u m 13ERL~iuD in the Commonwealth of Pennsylvania The petition of [he undersigned respectfully represents that: 1'ou~~ petitioner(s), ~~ho isiare 18 years of age or older an the executri named in the last will of the above decedent, dated A-PR~L /9 , ~1d0~ and codicil(s) dated (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in CLlM8E~2Lf~ND County, Pennsylvania, with her last family or principal residence at IOSS- G /SFLLEN~f3[F iPo.¢.d, /y/ECHfIrYICS- Sv~c'G (uP/'~z A~GGE'N TG~RJ (lisp street, number and muncipality) Decendent, then 22_ years of age, died ~uG us T / , ~zooz , at Holy SP/~ti i HOSP/Ti~~ ~ E.¢S'T PE/Y/YSBD.QD TwP. C~L(A~J.~7L~CJ~ C.~fIA/T~. Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated Incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ .?5. Door °O (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: N~/¢ -GriAs ff RHYT~Q~i~-rYRNT WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters T~"e'ST.f//J/~7VTAr2Y (testamentary; administration e.t.a.; administration d.b.n.c.t.a.) theron. x ~~~ c-~.5~. i? v E~~/rVE [ , SyEcc .~ ~ ~~ .PED T,~/K iQo,¢~ v ,8o/L/NG SPR/N6S, ~A /7gD7 f OATH OF PERSONAI. REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA l ~~ COUNTY OF _~Cu!'n LiERL~4ND The petitio, er(s} ~.uove-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct. to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and~t~ruly administer the est®®at(~e~according to Iaw. Sworn to or affirmed and subscribed K ~C~~~~' ~ ~3'Y14 ~ ~, before me this ___ day of E/~11iNE G S~/ErG A AUGUST 2ZZ RED 7~3+rV,C ~Or4~ .. (~ ~ 23olLiNG SPR/•YG'S~ /~if /7LM7 e ister y~• 7/T- Sip ' SSSZ 1~-8t- 13 No. ~.t- 02--132 Estate of Ed~tWIA E PACKER A_K_A_ F F PA('KFR ,Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW AUGUST 15, 2002 x.~xx , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated WILL: 4-19-2002 `~ i_. described therein be admitted to probate and filed of record as the last will of EMMA E PACKER A.K.A. E E PACKER and Letters TE TAMENTARY are hereby granted to ELAINE L SHELL FEES Probate, Letters, Etc. ......... ~ 60.00 Short Certificates( ) .......... $ 9.00 Renunciation ................ $ jcp ~ 5.00 TOTAL $ 74.00 Filed . , ,8-15-2002 mailed 'to' a1/ty' 8='1'5=20'02..... . ~i c - ~r Register of Wills .ATTORNEY (Sup. Ct. I.D. No.) 3d~S/3 ~ CtouSEa2 ~D. /hEC'Ni1N/Cs,SUQIs, /Jff / 9055 ADDRESS ~~~ ~~~ -o zoq PHONE is is to cerriEy that the information here given is correctly copied from an original certificate of death duly filed with me as local Registrar. The original cerrificare will be Fo(tivarded to the State Viral Records OfE(ce for permanent tiling. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, X2.00 P 8468314 No. ~ a3 Rev. 2/87 STATE FILE `LUMBER NAME Of DECEDENT (Frw. Middte. Lag) SE% SOCIAL SECURITY NUMBER DATE OF DEATH ~MCnm. Day..rear1 ~ 'Emma E. Packer ,.Female ~. 172 - O1 - 241 2 .. ( ~ ~ -> L~(1Z _ AGE(Law exmtlay) UNDERIVEAR UNDERIDAY DATE OF BIRTH BIRTHPLACF:Cey and PLACE OF DEATH (Cnecx nrly nl~e- n,snuclx,l ~tnel duel Month r Da Hows r Mnuln ~MOnln. Uay rears Slatep fcregn Counuy) Ye HOSPIU OTHER' 9 2 Y~ Feb 3 ,1910 Harrisburg , P I^~~^'~ ER,LD~^•^t ^ ~A ^ ~ormlrtg ^ Rssdenc• ^ asPe~am u s. e. 7. ,.. COUNTY OF DF.yQH CITY. BORO, TWP OF DEATH FACILR`/ NAME (II na inw•Mwn. give serer anU numoah WAS DECEDENT OF y11SPANIC OAIGIN? RACE . Amancan Indan, Bluk, wnae. etc. No ® rn ^ n y«, spaclfy cILD.n. (slim) Tw r P b ~' ' l d -/ East enns or .~ Cumber an ~ 1~~ILkt M.Aran.puenoAican.rNC White ' .e I . k. ed. „ DECEDENT'S USUAL OCCUPQION KIND OF BUSINESSIINDUSTRV WAS~DE DENT ERIN D CEDEN SEDUCATION MARITAL STJVUS-Manwd SURVIVING SPOUSE (Goa knd d wwk done dung moy U. S. ARMED FO EST S ~ on n. ew ~ ode corn Ieu Never MarrlW, W'Idowed. III wile. yva rtlaltlen namal d working Me: m not use retied 1 Wa ^ ~ ® Elements /Secondary Collage Drvwced (Bosch) 121 (1 aa5~1 YJidowed Homemaker Hone . ~~. „b• ,,. ,,, , „a. DECEDENT'S MAILING ADDRESS (Serxl, Clry/Town. $Idre, Zry Codel ~~ll DECEDENT'S PA Lr3J Y Upper Allen li ACTUAL 17 17 d d d i S 1055-G Allendale Road M, K• wa v n •. late Did 0. twp_ RESIDENCE dacedeM ~Iechanicsburg,PA 17055 ISea mmructwna live n ^n«herwtle) Cumberland townshlP9 ^ ~ "; ° ~"l , t7a a > el t7beoen . cdYrOOro. FATHER'S NAME IFuw. Mntlb. Law) MOTHER'S NAME IFxw. Middle. Malden Surname) t,. k T9. Anna Lin le INFORMANT'S NAME (Typa/PrinU INFORMANT'S MAILING ADDRESS ($Ire91. ClrylTown, Srele. Zp Code) 4,..Elaine L. Shell ggb.222 Red Tank Road, Boiling Springs, PA 17007 METHOD OF DISPOSITbN DATE OF DISPOSITION PLACE OF DISPOSITION. Name d Cemetery, Crematory LOCATION. CirylToym, Slate. Ip Coda Burin ® Cremators ^ Removal from State ^ (Hoorn. Dan Pearl w Olllsr Plu• oan.tien^ atwr,sPePMt ^ August 6, 2002 Mt. Olivet Cemetery New Cumberland, PA 17070 41a. tID. 4TC. 2f A. ' SIGN U OF FUNERAL SE ICE LICEN E PERSON ACTING SUCH LICENSE NUMBER NAME AND ADDAESS OF FACILITY - FO 012342-L tone&MurrayFH408 3rd St New Cumberlan ,z. 4:b , la itwns <onN wMn urtllyirp To Yrowredgs, Gath occurred al me Uma. date and pace soled. LICENSE NUMBEA DATE SIGNED Ls rtol avaaade al hme of d•]Ih 10 • catlly uup of death ( rcure Isle) r ~ ' (Hoorn. DaY. rearl . ^~ ~ 4~b. r~ any ~ ~~ ~ 4]c. lama 2e-26 mug W compM1e00Y TIME OF DEATH DATE PAON CED DEAD IM nm, ay. roar) WAS CASE REFERRED 70 MEDICAL EAAMINERICORONERT • person wro Pronounces desN. Vea ^ No ~ 1 ~ ~' _ 4.. ~ AM. 4s. . zs. 27. PAitT I: Enter ma diseases, iryurws w compbcahons which uuaed IM deem. Do not abler me mode of dynq, taco as cardi c w re uatory arrow, stuck or neon Lollar.. I Appronmal• PART 11: Other aignlflcaM condNOna contnWting to dear^. bin Lqt tuM/ orw cause on each Ilne. ~ IMerval0•IwNn not r•wm tM u rq n ndsdyag taus. given m PART I. I orwt and OeeN IYMEgATE CAUSE (Final [~ ~/^'1 ii S _ / /7 (~ dlsaasa w COndIxM G A /` ~ ~ CJ ~ I i ~ `-• J IC.J ~p ~j _ reswkngntleaml-~ a. _ DUE TO (OH ASA CONSEQUENCE OFI: Spwntuny lint corWilgns b. if any, leedirp birmudiau DUE ID(ON ASACONSEOUENCE OFD: I cause. Eller Ut9DEALYIND • CAUSE IDrseasew ntiry c. • ~MV1ale0 averse DUE TOIOFI AS ACONSEOUENC~OF1. IesWtag n deaml LAST ~ d _~ WAS AN AUTOPSY WERE AU70PSY FINDINGS MANNER OF DEATH DATE OFINJURV TIME OFINJURY INJURY AT WOAKT DESCRIBE HOWINJURY OCCURRED. PERFORMED? AYAMBLE PAgR TO IMmm. Day. Pearl ~ OOH ON Of CAUSE Nalursl H d ~ om!c • J Yea ^ No ^ ~~ ACCIdaM ^ Pentllrp lnveslgatxJn Yes ^ No Ves ^ NO ^ Sux:ids ^ Could rot be derermmao ^ 70e. __T00.__ __ M. a,0. _ aeC. PUCE OF INJURY ~ AI home, tar treat. laCtory, unite LOCATION (Slrrrel. Ciry(f wn. Stalej GuiUing, alt. ISPecdvl 2M. 410. z9. 30•. 70f. CERTIFIERICneck ~~ry onel SIGNATUREA TITLE OF CERTIFIER •CERTIFYING PHYSICIAN IPhysx:lan cenaymq cause w deem weer anOlhw unvsc~an nos Dromurxetl deem anu camPleled Ite,n 271 T 11 D f l k hd d m ' u o now q•, N ea o ra mY oeeuryed due to the causelsl and manner a• slated ..................................................... ^ Vr ~-'~ ' J b. • ICENSE NUMBER DATE SIGNE onFr D y. Year) 'PRONGNINCINC AND CERTIFYING PHYSICIANIPnyscan tluln u~nnour~c:ny ~ealh and cerulymylo cause of uealnl /- M QQ ~ ~ ~ ~ / To tM heal of my krowl•dgw, death occurred at M• tlme, date, ono place, and dw to m• cauu(a) and manner as elated .......................... (_ Jlt_ _ `/ - 71d. ' _ NAME AND ADDRESS Of PERSON WHO COMPLETED CAUSE OF AT • 'MEDICAL EXAMINERICORONER On the 0esis of asaminalfon andJw investlgatton, in my opinion, death occurred at tAe Ilme, dale, and place and due to the cause(s) and _ Item 27 T 1`C / MQk.^ ypew not /" /~ ! L/" I r n /~ ~ ~ 2 ' /~' ~. -J Y~1 ~ , manner as eared .......... ..... .... ..... E ~ , , A /- ) / J'~ ~ O ~V ~ .G`J 1 l/Lh~ a.J I•~~ °ia az. ~ / O J REGISTRAR'S SIGNATURE AND NUMBER /J ~ ~~ ^ ` / ~, / ----~- DATE FILED rM nth De real) Local Registrar BUG 0 3 2002 f~a~z COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH i LAST WILL AND TESTAMENT OF EMMA E. PACKER 21-02-732 I, EMMA E. PACKER, also known as E. E. PACKER, a single woman, currently of 1055 Allendale Road, Apartment G, Meadowood Apartments, Mechanicsburg, Cumberland County, Pemisylvania, 17055 being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. All the rest, residue and remainder of my Estate, real, personal and :mixed, whatsoever and wheresoever situate, is to be distributed to my daughter ELAINE L. SHELL. In the event she predeceases me, then all the rest, residue and remainder shall go to to my son-in-law JOHN M. SHELL. In the event he predeceases me, then all thc; rest, residue and remainder shall go to to my niece ALBERTA MAE ROGERS, en r stirpes. 3. I nominate, constitute and appoint my daughter, ELAINE L. SHELL , to be the Executrix of this my Last Will and Testament. In the event that she is unable or unwilling to act as Executrix, I appoint my son-in-law JOHN M. SHELL to be the Executor :in her place and stead. In the event that he is unable or unwilling to act as Executor, I appoint my any niece ALBERTA MAE ROGERS, to so serve as the Executrix in his place and stead. I further direct that they shall not be required to file bond or other security in the Office of the Register of Wills for the purpose of administering my Estate. Iii WITNESS WHEREOF, I have hereunto set my hand and seal this ~ day of --~~t""~ A.D. 2002. ~ ~~~~~~ EM1kIA ~: PACKER ~ ~~ ~~~ ~~ a/k/a/ E. E. PACKER (SEAL) (SEAL) Signed, sealed, published and declared by the above-named EMMA E.. PACKER, also known as E. E. PACKER, as and for her Last Will and Testament, in the presence of us, who at her request and in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses. J F (,~cc~P.~ e ~ ~--- REGISTER OF WILLS OF C ~ rn Q~~~N~ COUNTY OATH OF SUBSCRIBING WITNESS 21-02-`1 ~~_ CHf>-r2L~5 E: SH/CZUS__ .,11L {eat) a subscribing witness to the will presented herewith, Feaefr} being duly qualified according to law, depose(s) and say(s) that f/E Ltr.¢S present and saw the testatrrX ,sign the same and that KE signed as a witness at the request of testatri in er presence and (in the presence of each other) (in the presence of the other subscribing witness(es)). Sworn to or affirmed and subscribed before me this yTH day of AUGUST aa~z t Regtster Gt fe Cloccs~ R,1>. (Name) rnE-Cygyres.c4 urzG, P,9 /70 SS (Address) (Name) (Address) REGISTER OF WIL OF COUNTY OATH OF NON- SCRIBING WIT (each) a subscriber reto, (each) being d qualified according to w, depose(s) and say(s) tha familiar with a signature of , codicil testat of (one of the su ribing witnesses the will pres ted herewith and codicil that believes the signatu on the will is in the andwriting of to the best o ltnowledge and belief. Sworn to or affirmed a subscribed before me this day of (Name) Register (Address) REGISTE~ OF WILLS OF COUNTY O?~.TH OF SUBSCRIB ~ ~'[TNESS codicil (each) a subscribing wi ss to the will presented h ewith, (each) being duly qua ~ led according to w, depose(s) and say(s) th p ent and saw the testa ,sign the same an hat signed as a witness the request of test in l~ prese a and (in the presence of ea other) (in the presence of t other subscribing w~ ss(es)). rn to or affirmed and su ibed before me this day of (Name) 19 (Address) Register ~-. (Address) REGISTER OF WILLS OF C u mdE~~NA COUNTY OATH OF NON-SUBSCRIBING WITNESS 2--0~- --~3Z ,~'L~/NE ~. .SyE~L -- -{eae-l~ a subscriber hereto, feaek}~ being duly qualified according to law, depose(s) and say(s) that SNS' is familiar with the signature of E/y!%1r¢ F PiASC~.FX~ afar EE'/'~sxCXt~ t~iti~-- testat hex of the will presented herewith and codicil that -sy~ believes the signature on the will is in the handwriting of ~liYAlyr .F ~ilCKEii ; ~t.C~a ~ E. ~ifL~K~~t' to the best of .~E~c' _ knowledge and belief. ~~ ~ ~, Q Sworn to or affirmed and s~xbsaihed "~efore X ~~ °~"~~ "'`'' ~~ "`~' me this 1 ~~ _ day ~f E~rN`C ~~ SHEUName) 2~~ ~ ~k AUGUST _ ,SD/L/NG .SCR/Mss .~ /7~7 ., m ~ f G:,.,,~ (Address) R (Name) (Address) RE'o/'15aaEXi6-Da', COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 /?-?/- /3 REV-1500 W I- )::::!oo ,,0:'" w"" :roo ,,0:-' ..Ill .. " INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z W C W o w c DECEDENTS NAME (LAST, FIRST. AND MIDDLE INITIAL) -PA-C 1< 1<1'1 ,Efl1/UA- E. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 01-01-2002 tJ2-/3-/9/tJ (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST. AND MIDDLE INITIAL) Al/A- ~ 1. Original Relurn o 4. Umiled Estate !2Q 6. Decedent Died Testate {Attach copy a/Will) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (dale of death after 12-12.62) o 7. Decedent Maintained a UlJlng Trust IA\\acti c01Y.l 01 Trust) o 10. Spousal Poverty Credit (date ofdaalh between 12-31-91 and 1-1-95) '. J~': / FILE NUMBER .2 ( .-2 ...d COUNTY CODE YEAR ~!?...~~~ NUMBER SOCIAL SECURITY NUMBER 172 - 01 -;Z'fIZ-- THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Return (dateo/death prior 10 12.13.82) D 5. Federal Estate Tax Return Required o 8. Total Number of Safe Depos'lt Boxes o 11. Election to tax under Sec. 9113(A) (Attach 5ch 0) I- Z W o Z o .. Ul W 0: 0: o " THI5 5ECTlOf'l.MUST Be COMPLETED. ALL CORRE5PONDENCE"ND,COIlFI1I!'NTIALTAX INFORMi'T10ll SHOULD BE.QIRECTED Te>: NAME CII/!teL€ S E. 5/11 EC-OS JIJ: COMPLETE MAILING ADDRESS ~ CLOUS€R eD_ MECfI,4N Ie 5 ButeG, PA /7"s5 FIRM NAME (11 A.pplk:ab\e) TELEPHONE NUMBER 7/7 7(,4.-0209 z o !ci: .J ~ l- ii: <I: o W r:t:: 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Close(y Held Corporatkln, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property {Schodule E\ (1) (2) (3\ (4) (5) -0 't ::10, !?~D. Cf<f o (6) - 0 jI 81f._ iP 7 f 1ft?, s~Lf_ .3 7 , 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter.Vlvos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage LiabUlties, & liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) (7) - 0- (9) (10) t 3,3/9,00 '7'1. 3.;/ 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o < I-' :J Q. :E o o ~ 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 0 x.O~ (15) 'f S~, S'03./"(" x .0 'i5... (16) () x .12 (17) 0 x .15 (18) (19) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 141axable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUE5TING A REFUND OF AN OVERPAYMENT > > BE 5URE;Te> AN5WERALL 9UESTIONS Oil RI;VER5E .SIDE .AND RECHECK MATH < < I I OFFICIAL USE ONLY (8) % ~ 2, 2-01, 'It (11) (12) (13) 'f 3. 3'!S. 32- <$55'; .fo3. a" o (14) , 5t, ftl3, 'b o , ;;;',/"'IG.I(,, o o , ;; ,&l/("//" Decedent's Complete Address: STREET ADDRESS 10S5"- G /fLl i:/IIf)I9-Li: A?M.l> . CITY /J1 IFCH/MIfCS B ,(JeG I STATE /'/f. I ZIP 170$$ Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) ~ ,).,{,'I(../6 o o CJ Total Credos (A + 8 + C ) (2) o (3) 0 (4) 0 (5) ;t .;(/6<(6.1(, (SA) 0 (58) ~ :1,61( b./I, 3. InleresWenally if applicable D. Interest E. Penally o [) TotallntaresUPenally ( 0 + E ) 4. /f Line 2 is 9reater than line 1 + line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. 8. Enter the total of Line 5 + SA. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT ~]:~~~t;'~~:':'i~;~J~~~~j'i;~~;i':;.'~);:~~;~~~~~~:.I-"r,f;r]1~:~!m,~~i\1J~~,~~;,_~,,!,~~~C"~~~:~~;;j:f,<~~E~.~~~~ j';f<~ttJf:::.',i.~~.':Y!l" PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. re/ain the use or income of the property transferred;"""""..""""""""......"""""""""""""""""....""""""""" b. retain the right to designate who shall use the property transferred or its income; ............ ............................... c. retain a reversionary interest; or.... ,............,.,.,...,..,....,.,........... ...................,........... ..................... ... ................ .... d. receive the promise for life of either payments, benefits or care? ...................................................................... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .......................,............................ .......................................................... 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 4. Did decedent own an tndividual Retirement Account. annuity, or other non-probate property which contains a beneficiary designation? .............................................................. .......................................................... Yes o o o o o o o aa IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN, No ~ I2SI ~ [LJ ~ Under penalties of perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the Des! 01 my knowJedge and beJief, it is true. correct and complete Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. o/<//vG S;tJ~/IIf(;J, /III f7fX)7 ENl~ '/ftelG5 iF. Sf{ leU>5 ]]f CLOU5GfN ~DI9-0/ /J1€C#-1/YICS8UJ(lp-, flA /7",sr DATE DATE >-{q-o,; For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for tile use of the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from lax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: Toe tax. rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of/he child is 0% [72 P.S. ~9116(a)(1.2)J. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%. except es noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)]. A sibling is defined. under Section 9102. as an individual who has at least one parent in common with the decedent, whether by blood or adoption. , REV-1503EX+{1_97) . SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF .21- 02-7.32.. Pltctee I FILE NUMBER E/11/J1A E: All property joinlly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. VALUE AT DATE OF DEATH H ILL/t'tR.D LYONS, INC!. PROCElFt:>S CHECK FoR S/TU;: of Pt(TIl//'fnt Ft(IVj) .5#/'fRES SoLI> BEFo/e,F PAre .oF DGRT/Y' (&flY of P/l.PCE'EVS Cfft:CK A TTACffEIJ) 'it PfO, F?.?o. 9'1 TOTAL (Also enter on line 2, Recapitulation) $ ;;to, 8 80. 'lot- (If more space IS needed, insert additional sheets of the same size) J, b' ~ I K fiJ"tf1 * Jd. fII~~;"'~~~~U sl~~'n.w~~~~11 -~ I ,<__~~!~!:~f~. f "~-~~;jt!JI"~~ "H" I' ~@N'l/tJ.~ ~ H1H~M!i I ~j, lffi&ij(J '~ 'e - 1ilW1I~ - '/l1",f/!1lO !;1 f,b'~f,'i @'t! h~' (j I., fI ~ _ _I!ilFl",~ '/l1",1!i€i~ 11 I jj 11 (f~~/~ _ 1ilW1I hl/OIYi-ii tt ~~ ~ I\i ~ ~ ""il ~ ~ ~~ ~j~' ; I ~j~nf' : i ~~H~~1 ; ; a: ~ I~.l~ ~ : >- ~ ~1' c ~ ~w" I '" I - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -.- - - - - - -- e ,~IlcllMENT'CHANQcS;lltlLO~, UA ;~Iilll'\'. J:lARIt1iO'. 'WtllfJ:lllilItI!RAq"'A$Hf,,"II, . ". . .,. "1f,fjlUtfi(iIm'.bn'L,"crQiVS:<'fNC: !;:-" "\<'~.;;8i\Y . 'i;;':?~I<)~).1jf.} ';!ii'Ci'B;,:1i~;!JlA=,a!9'<iY :",td~l.sviQiE)'.K~;r:utk.Y;"i."....'....'.,'.. ..'.;....... i~:i~';;<....r;,....!'...~;;~;~';..U'ii..i'..;...'....,,..).! ...~~Y(I.~S1lJ!;f<l!XCltA_,NC, ..... ., .' 7/,1i8Y02;"A~"**~26BBO';94; .... ...... . _,C'_,' . >. ',n ",' '._ "_.' "., ','-" .' _,_' _,., ",'" _: '. "".,_ ',....:.. '. ~1~,lI.;t';i!tTI~~ . EMMA E PACKER ELAINE L SHELL POA 22.2 RED TANK RD BOILING SPRGS PA 17007~9556 VOID AFTER lBO' DAYS . '~f;~TH\; -~, :,.:;T' 1 " j i II~~\HE I rRDER OF II" 7 2.1, :1'111" I:OI,:I:lO.b 271: .00'1 5b 2 :151,11" "- -.- -- - -- .--- -- _.- - - ---- .-- -- ...--- '- - - --. - ----. --- ..-... -- - -- --- - _. --.. - - - --_. -. ""~".''''~ '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF :21-02- 732 P~CKE~) EMMit FILE NUMBER E include the proceeds of litigation and the date the proceeds were received by the estate. All property jointty-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. ~, 3. 1. s t,. 7. DESCRIPTION VALUE AT DATE OF DEATH ~';;73'1 ~'1g, 0~ I11Me( i" /till/let /A1f/i:N1tJtzy LIST of PE/?SOI/!HL TY (ATT/l-Cf/IFD) R~F/( N}) oF' WIE'.t711/6L Y t<1/mL>R/lNJ1/ ~CNI-L s;e;CU/2ITY ClVG'CK ~ss: 00 (/VAS ~y /NUU/)/:'t) MI j).p.D. V/fLu5 /4/ /1-t!(!.t?trIllT ITEMS bAl SCHe-.D. F.) A.J/A t<EFUNP CHECK.: JJA. I3LuE SfflB.D ~ .:<47. 1'1 , "/05E,J!l-" ,&rM!Al8S 5JNI, R.IiTu~N of secuttlry DEPtJsl-r ::Pt7A1EG/I-C. /J'Iu7Zu9'L - REFUND oN R6/V1-rgf/S /NSI-/I(ItNC,t: &mc/lsr A'5FtI/VD VlECk; I" .:( t:l. 00 ,. 33.00 ~ 51'. '1'( ~{Io./;7 TOTAL (Also enter on line 5, Recapitulation) $ (if more space is needed, insert additional sheets of the same size) ~ s: n ,- Er/vlf- E'. Pit C IcE R INVENTORY OF PERSONAL ITEMS 1 old and reupholstered couch 2 old and reupholstered chairs 1 real old mattress/boxspring 1 small bed 1 veneer, distressed dresser 2 end tables 1 coffee table with finish eaten into, warped drawer 2 old stools 1 formica kitchen dinette set with 4 chairs 3 TV trays Miscellaneous pot, pans and assorted kitchen utensils Old regina upright sweeper I table lamp Plastic flower centerpieces Green vinyl ottoman 20" Magnavox Color TV-picture tube fading 1 TV stand, pressed wood 1 Old iron Ironing board Clothes Hamper Kitchen trash can 2 Small trash cans TOTAL ;2/- 0:< - 7"3;Z $20.00 $15.00 $5.00 $7.50 $15.00 $5.00 $7.00 $2.00 $45.00 $1.00 $10.00 $15.00 $1.00 $0.00 $1.00 $10.00 $1.00 $0.00 $0.50 $0.50 $0.25 $0.40 - $14865 ~ c-- PEN\!SYLVN\JI/\ BLUE SHIEL[; :\HI(;IlI\I.\I",(()".If':\N' Date: DECEMBER 27,2002 "~! f:-, I .': E }- .;-.,C~,:Ef. 222 RED TANK ROAD BOILING SPRINGS, P A 17007 Please find enclosed a refund check for the unused portion of the Pennsylvania Blue S"';'>'~ "rPffil"um po'~ent .. ...~. ~"c'-.rJ ... ~ ''-.l1.U . Thank you. Membership and Billing P.O. Box 898248 Camp Hill, P A 17089 Fax: (717)731-2985 Encl osure Clmp Hill, pClll1svlvJni;1 i 7(11\') www.pahlllt.snicld.com P"nn.ylvani.l 81v~ 5hield i. an Indep,."denl Lic"nsl'~ {Jf the 8/up eros. and Blue Shield Asmci3liun <J-1IGHJVMKc P.O. Bo" 890089 Camp Hill, P A 17089-0089 UlGHMARK RESERVi;S THE RIGHT TO RETAIN THE REMITTANCE COPY OF INVOICES INVOICE NO. P.O. NUMBER DATE VOUCHER GROSS AMOUNT DISCOUNT NET AMOU NT REFUND 2002-12-U 00442515 287.14 0.00 287.1' HNDLr CHECK NO PAY DATE [ VENDOR NO I VENDOR NAME TOTAL AMOUNT T 30361844 2002-12-26 I EMMPAC0002 I EMMPACOO02-001 287.1' PLEASE CASH OR DEPOSIT CHECK PROMPTlY 0000165 It WARNING THIS DOCUMENT HAS A COLORED BACKGROUND AND AN ARTIFICIAL WATERMARK ANY ALTERATION voros THIS CHECK <J-tIGHNV\RK Ca~pHiII,P:A I~ PNCBANK :JEAUNEn~. ,PA' CHECK NO. 30361844 TWO HUNDRED EIGHTY-SEVEN DOLL.4li5:A.ND 14 CElII1S ,'-nA TE .OF -CHECK- MO, DAY YR 12/26/2002 ~ MUST BE CASHEDwlTHtN 6 MONTHS ESTATE OFEMMA,E. PACKER 222 RED TANK RAOD BOILING SPRIGNS, PA 17007 AUTJIORlZ~D SfGNAIJ:1RE, Highmark/1nc.. 1I.:l0:lI;lo81,1,1I.1:01,:l:lOloI;271: 0002 lo 5 lo 20811. :~'''EX'~'') '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTL Y.OWNED PROPERTY ESTATE OF P,tfCK.67<, EMMA FILE NUMBER :l/-o~- 732 E. If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. FL.-IIN/: L. :5#t: LL ~;{.:z Jec:D TANK BOILING SPRiNG S . 7?D~l> PA 11M? 'pJ4U~HTee.. B. c. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH lTEM FORJDlNT MADE Inclurle nama offinanc\aI institution and bank accounl number or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT deedforjotntly-heJd real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. U/-Pi- PNC BANK C J/[;CkING: A-cc.-r: %.6; 0"1 :? '1'1 SO/" ,1f /11(; :l, S"'. Z.,Z # 5/'f 00 if 8' /5fo 2. /I. 177. -f'- PNC S,<fNK S/!-nl'tGS AeCT- 1 SlJf.. 1. ZII"I S~{)9'-/.79 ::<7, Slf7. ifo iF- .s-PO 35'3 ,-/-/,09 3. /I. C1-ZD- f1AJC L3AJlJK (!F~T/F. OF :/)tFPOSiT If I' 217C/ 20, 6' 2/. S1) SbZ /~ if/0,7S" -# 31000:L13230 (SFt: 7f'..eEE NPnCtFS ~/H PEPT. "F ~E't/evtlEf A-rr.JftJHFl:> ). TOTAL (Also enter on line 6, Recapitulation) $ 1j-o, .!>tJ'I. 37 - (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *' XNFORMATXON NOTXCE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 02-0732 02144698 10-09-2002 IEV-lS4JElI'AFP U9-UI TYPE OF ACCOUNT o SAVINGS IXJ CHECKING o TRUST o CERTIF. TO: EST. OF EMMA E PACKER 5.S. NO. 172-01-2412 DATE OF DEATH 08-01-2002 COUNTY CUMBERLAND ELAINE 222 RED BOILING L SHELL TANK RD SPGS PA 17007 REMIT PAYMENT AND FORMS REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PNC BANK has providtld the IlBperblent with tha infor.ation listed beloN Nhich has been used in calCUlating tha potential tax due. Their records indicate that et the death of the above decedent, you were a joint oNnar/benaficiary of this account. If you feel this infor~tian is incorract, plaase obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordanea with the Inheritanca Tax Laws of the Co.~nwealth of Pennsylvania. Questions .ay be answered by calling (117) 787-8327. Dat. Established REVERSE SIDE FOR 01-01-1978 FILING AND PAYMENT INSTRUCTIONS COMPLETE PART 1 BELOW Account 110. 5140048156 I( I( I( SEE x 5,092.44 50.000 2,546.22 .045 114.58 To insure proper credit to your Bccount, two (2) copies of this notice .ust acco.pany your payaant to th& Resist.,. of Wills. Make chack payable to: "Register of Wills, Agent... Account: Balance Percent Taxable AMount Subject to Tax Tax R.te Potential Tax Due x HOTE: If tax pay.ents are aade within threa (3) months of the dec.dent's datp of death, you aay deduct a 5% discount of the tax dua. Any inheritance tax due will bacome delinquent nine (9) .o~ths after the date of death. PART TAXPAYER RESPONSE ill !l:1,!]II,j!~~'::!fI~J~!:I!I~,milfll._~~lm.~I.~I~~~\Ii~-P.."li~.~II,:i[~. 'm\~~. Fi~. _.,.,...,.......,......,.. ._.,.,.............(....,.,.,...?~.,...............r. ._.._............,.".,~.,.,~.,.,......,.......... ..._.,._.........,...~.,...r.,~,~..~...,...~.,..~."'.~......,~,.,... .'.'.'~r. .,....,.,......,.,.,.-........,...,....,.,.,....,.... ..,.,......-.-..........,.,......,..,.........,.,.,'.-.............., ,.,....-....,..,.,...,.,.,-.-.......... ,.,.,.,.... . ....,.....",.,.,.., ........ .... ..-...,.,.,.........-.....,.-.................-.-.......-........ ...........-. .......................-.-......................-..-............ . ......-............,.,....... .............,.....................,....... ...........,... ........ ............~................. ....... ...........,........ ......... ........ ... ....... .......... ..... ,..... [CHECK ] ONE BLOCK ONLY A. 0 The above infor_aUan and tax dUB is correct. 1. You.ay choose to rBlllit payeent to the Register of Wills with two capias of this notice to obtain a discount or avoid interest, or yoU ~y check box "A" and return this notice to the Register of Wills and an official asses~ent will be issued by the PA Depart..nt of Revenue. B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. C. D The abova info~ation is incorrect and/or debts and deductions were paid bY you. You .ust cQIIPlete PART 0 and/or PIlRT ~ below. PART ~ TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. AMount Subject to Tax 5. Debts and Deductions 6. AMount Taxable 7. Tax Rate 8. Tax Due TAX ON JOINT/TRUST ACCOUNTS If you indicate a different tax rate, please state your relationship to decedent: OF 1 2 3 4 5 6 7 8 x x PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I $ I TOTAL (Ent.r on Line 5 of Tax COMPutation) declare that the facts I have reported above are true, correct and and belief. HOME WORK LE (O"5."%-- DATE COMMONWEALTH OF PENNSYLVANIA DEPARlHENT OF REVENUE BUREAU OF INDIVIDUAL TAKES DEPT. 280601 HARRISBURG, PA 17128-0601 *' 7NFORMAT70N NOT7CE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 02-0732 02144697 10-09-2002 tEV-154S EX AFP U,...Ol EST. OF EMMA E PACKER 5.5. NO. 172-01-2412 DATE OF DEATH 08-01-2002 COUNTY CUMBERLAND TYPE OF ACCOUNT [Xl SAVINGS o CHECKING o TRUST o CERTIF. ELAINE 222 RED BOILING L SHEL L TANK RD SPGS PA 17007 REHIT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PNC BANK has providad the Departllflnt with tha infor.ation listed below which has been used in calculeting the pobntial tax due. Their records indicate that at the death of the abovlI deced..,t, YOU were a joint owner/bllnaficiary of this account. If you feel this infor.ation is incorrllct, pleasa obtain writtlln correction fro. the financial institution, attach a copy to this forlll and return it to the above address. This account is taxable in accordance with the- Inheritance Tax Laws of the Co..onwealth of Pennsylvania. QUllstions .ay be answerad by calling (717) 787-8327. COMPLETE PART 1 BELOW Account No. 5003534609 I( I( I( SEE Date Estab1ished REVERSE SIDE FOR 02-16-2001 FILING AND PAYMENT INSTRUCTIONS PART [!] 55,094.79 50.000 27,547.40 .045 1,239.63 TAXPAYER RESPONSE il!!il~~i~~I!I!!!!~i!!!~.II1!!!!I~I!!!I!IIll!~!I!~~I~~jl!!!_1~1!~!mllr.m!.~m..!~!.j!!!~I~I!i~.~U!!!!!ii Account Ba1ance Perc.nt Taxable Amount Subject to Tax Rat. Potential Tax Due x To insure proper credit to your account, two (2) copies of this notiCII must eccoepany your pay.ent to the RBgister of Wills. HakB check payable to: "RBgister of Wills, Agent". x NOTE: If tax paY8lmts are .ade within three (3) months of the decedant's date of death, you gay deduct a SZ discount of the tax due. Any inheritance tax due will bBco8e delinquBnt nine (9) months aftBr the date of death. Tax [CHECK ] ONE BLOCK ONLY A. 0 Thll abovB informltion and tax due is correct. 1. You .ay choose to remit pay.ent to the Ragister of Wills with two copias of this notica to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Ragister of Wills and an official asseSSMent will ba issuad by the PA Departmant of Revenue. B. l"ti The above assat has bean or will be reported and tax paid with the Pennsylvania Inheritance Tax return ~ to be filad by the decedent"s rBpresentative. c. 0 The above infor.atlon is incorrect and/or debts and deductions were paid by you. You must co.plete PART ~ snd/or PART ~ below. PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED If you indicate a different tax rate, please stat. your relationship to decedent: PART ~ TAX RETURN - COMPUTATION lINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rat. 8. Tax Due OF 1 2 3 4 5 6 7 8 x TAX ON JOINT/TRUST ACCOUNTS x PAYEE DESCR I PTI ON AMOUNT PAID I $ I TOTAL (Enter on line 5 of Tax Computation) of perjury, I declare that the facts I haye reported aboYe are true, correct and of my knowledge and belief. =if HOME ( WORK TELEPIjO .',". .....,."....j.t:'.-; IO./~.(JZ-- DATE COMMONWEALTH OF PENNSYLVANIA DEPAITMENT OF REVENUE BUREAU DF INDIVIDUAL TAXES DEPT. Z8D601 HARRISBURG, PA 171Z8-06Dl *' ZNFORMATZON NOTZCE AND TAXPAYER RESPONSE FILE NO. 21 02-0732 ACN 02144699 DATE 10-09-2002 REV-1.54S EXU/> (!l9-IDJ EST. OF EMMA E PACKER 5.5. NO. 172-01-2412 DATE OF DEATH 08-01-2002 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST IXJ CERTIF. ELAINE 222 RED BOILING L SHELL TANK RD SPGS PA 17007 REHIT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PNC BANK has providrad thra Drapartllrant with tha inferBation listed below which hills beran used in calculillting the potentiilll tax due. Their records indicate that at the daath ef thra abova decadent, you wrare a joint ownrar/baneficiillry ef this acceunt. If yeu feel this infer_.tien is incorrect, please obtain writtliln correction froe the financial institutien, attach a COpy to this for. and return it to thra abeve address. This account is taxable in accerdance with th8 Inhraritance Tax Laws of the Coa.onweilllth of Pennsylvania. QUBstions may be answered by calling (717) 787-83Z7. COMPLETE PART 1 BELOW . Account No. 31000213230 . . SEE REVERSE SIDE FOR Date 07-20-2001 Estab11shed FILING AND PAYMENT INSTRUCTIONS Account Balance 20..821.50 Percent Taxable X 50.000 Allount Subject to Tax 10..410.75 Tax Rata X .045 Potential Tax Due 468.48 PART TAXPAYER RESPONSE [!]iii!I!;~~~!llliii~tii!i~..ilill~~~!I!il~lf,i~!~r~i!.11IIE,~~~I!~i~i~.i!I!~_II.i!!!.~gililal!II~~~ili!I.~.ii!li! Te insure proper credit te your iIIccaunt, two (Z) cepies ef this net ice Bust Bccaepany your paY.llnt te the Register of NUls. Make check pey.ble to: "Register of WUls, AliIlIllt... NOTE: If tax payments are .ade within three (3) eanths of the decedent's datil of death, yeu BBY deduct a 5~ discount of the tax dUB. Any inheritance tax due will beco.e delinquent nine (9) .onths after the dillte of death. A. D The above inforeatian and tax due is carrBct. 1. You Bay chaasB to remit payment to the Registlilr of Wills with twe copies of this natics to ebtain ill discount or avoid intsrBst, or you lRIy check box "A" Bnd return this notice to the RBgister of Wills and an official assessaent will be issuBd by the PA DepartmBnt of Revranue. [CHECK ] ONE BLOCK ONLY B. rv1 The abovra asset has been or will bs reportsd end tax paid with ths Pennsylvania Inheritance Tax rsturn ~ to be filed by the dlilcradsnt's rrapresentative. c. D The above infor.ation is incorrect and/or debts and deductions were paid by you. You .ust co.plrate PART ~ andlor PART ~ below. If you indicate a different tax rate.. please state your relationship to decedent: PART l!J DATE PAID DEBTS AND DEDUCTIONS CLAIMED PART ~ TAX RETURN - COMPUTATION LINE 1. Dat. Established 2. Account Balance 3. Percent Taxable 4. Allount Subject to Tax 5. Debts and Deductions 6. A_ount Taxable 7. Tax Rate 8. Tax Due OF 1 2 3 4 5 6 7 8 X TAX ON JOINT/TRUST ACCOUNTS X PAYEE DESCR I PH ON AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ declare that the f.cts belief. ~ I have reported above are true.. correct and /0 -/S"...,z DATE REV-1511 EX+ (12~99,\ _V'l~'~.. ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF 'FA- eKE 1i?.1 € ntll! If E. FILE NUMBER ;;u -o~ - 7 3:z. Debts 01 decedent must De reported on Schedule 1. ITEM NUMBER A. FUNERAL EXPENSES, 1. DESCRIPTION AMOUNT :/. :l"t<rY\l<S' GINGI(ICl-\ IV\El\\oI1IPrLS For< II\lSC.~IPIIDN ~rs-o.oo B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representativels) E tiliNG L. SHELt Social Security Number(s)/EIN Number of Personal Representative(s} Slreet Address ;), :l :J. REi) '1;hJI< 1<!oA b City 'BO\\..\t.l& S.PA.INGS Slate ~ Zip /7007 WA-nIED Year(s) Commission Paid: 2. Attorney Fees C I; I'rJO!.LES E SH I E:L,[)s 'llL , .:2, 8 5V. ro 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant "lDf,}E" NONE: Street Address City State ~ Zip Relationship of Claimant to Decedent 4, Probate Fees _.I or"tjinCl\ ',SSue "f sh.rt Ce.rtd;'c.Je.s 17'1. Of) 5. Accountant's Fees 6. Tax Return Preparer's Fees H iil' BLOCk:, Pl2ef' OF 10'10 a.osc-ou7, /0'1/ ,e'E", F;/;(j :Lnhe,,'fpnce %vy 1?efurn I 3 ClO." () ~ /.s-.OO 7. $ 1., 3 I G. 00 TOTAL (Also enter on line 9, Recapitulation) ..I " (If more space is needed, insert additional sheets of the same size) /_1 ," ~J2-li' I- - --- ~ James Gingrich Memorials Conf# 125107 5243 SIMPSON FERRY ROAD MECHANICSBURG PA 17050 8/30/2002 JOHN SHELL 222 RED TANK ROAD BOILING SPRING PA. 17007 Item Description ITEM SUMMARY Qty. Price Each Inscription work for: PACKER, EMMA 80.00 Total 80.00 - t- t- IJ c1;/F 4~ol O~ orl"()V Total 80.00 Lettering was done on: 8/30/2002 Please call us with any questions at (717) 766-5622 cut along dotted line Premium Plan Account Statement PNC J;.:IlIL. 7, -f '" ,.-0 PNCBAN< Primary account number: 51-4004-8156 Page 1 of 2 For tho period 07/06/2002 to 08/06/2002 Number of enclosures: 3 EMMA E PACKER ELAINE L SHELL 222 RED TANK RD BOILING SPRINGS PA 17007-9556 '!r For 24-hollr clIstomer service or ClIrrent rates: Call1-888-PNC-BANK Moving? Please contact usat '.S88-PNC-BANK tEl Write to: Customer Service PO Box 609 Pittsbllrgh PA 15230-9738 OJ Visit us at www.pncbank.com = ~ ~ TOO tenninal: '-80083.1-1648 For nearing impaired dicnt.~ only The PNC Bank Check Card. A More Convenient Way to Make Purchases. y (It I ClIl use )'Oll)" PNC Ballk Check Card for more thall just A TrvI access. Use it 10 make purchases t.~\'ery\\'her{' VISA 15 <\ccepted, over 22 1l1illiUll IOClliollS worldwide. It worksjusllike a check, onl)' bster aIld easier. And rig-hllIOW, using >'our card may pay in lllon~ ways 11Iaujllsl COll\'l"lIiellce! Vbit wWlv.pucbank.cOlll to read about other exciting feltures. A.Ill1 start paying with your PNC Ballk CIICCK Card IOtLty. Premium Plan Interest Checking Account Summary Account number: Sl-4004~81S6 Account link@ number: 0172012412 Emma E Packer Elaine L Shell 5,D~~.1l 9~8.S] Ending balance 12,162.01 Please see the Activity Detail section tor additional information. Balance Sunlnlary Begillning balance DepOSits and other additions 7,109.3 ] Checks and other deductions Average monthly balance 5,915.'11 Charges and fees 20.00 Transaction Summary Checks paid/ withdrawals Bank card/POS Account Information transactions asslstance calis Teller transactions ., ,> 11 0 j Total ATM transactions PNC Bank MAC Other MAC ATM ATM transactions transactions Other A TM transactions o o 0 (J As of 08/06, a total of $9.24 in interest was earned this year. Interest Summary Annual Percentage Yield Earned (APYE) 0.25% Number of days in interest period Average collected balance for APYE Interest Earned this period 32 5,9H1.-n 1.31 Activity Detail Deposits and Other Additions Date 0;;/02 Amount 'f:!5S.00 }(6,25().OO '>< LJ [ Description Direct Deposit - Soe. See. US Tre;1sury 303 172012-112A Deposit Reference No. 025891"173 Inl.t're.~1 Paymcllt There were 3 Deposits and Other Additions totaling $7,109.31. 0:), '05 OS; (H, k:-- ~.;&-~ .~ J'm.W~~ fJgA~~ FQRM953R Reviewing Your Statement G PNCBAN< Plc~.';e reVle\\' this st,l(Crllellr (:lrefully :H1d reconcile it with your records. Call the telephone number on the upper rigllt side of t\lC fIrSt p:lg-c or this SI:lIVlIH'1l1 if \'CHI h.wL' ;Jill' quc.\liollS rC';:lrdlllg ~'()llr ::lCCOlllll(s); Wlll1ll:JI)tC OJ' ;l<ldrt'ss is IIlOl!TCCL ;'0[1 11,1\,(,.1 ImsillCSS :1ccnlll1l ;lIld your t::lX idcllliflGltion number is missing or inconcct: \'llll h:]\'(' am qlll'slil,lllS regm-ding mlt'l'est !,<lid to nn illtert'.~t-b('arlng accOllllt. Balancing Your Account Update Your Account Register The activity detail SCCtl011 of your statement to YOUT account register. All items ill your accollnt register thm also appear 011 your statement Relllcmber to bet,rin with the t'lJding dale of your last statemenl. (.t\.n asterisk [*] will appe.lr in the Checks section if there is.. !,t;l]> in the listing of consecutivE' check IHllllbers.) Any de]>osils or :JdditiollS including intcreH paymenlS and AT~-r or electronic deposits listed 011 the statement that arc not already clllered. Any :1ccount deductions including fees ::lJld ATM or electronic deductions that are not already entered. Compare: Chec), Off: Add to Your Account Register Balance: Subtract From Your Account Register Balance: Update Your Statement Information Step 1: /\dd \l.lgt'Lher dcposiL~) ;]11(1 other ;J(lclirions liskd ill your :1CCOHnl rcglslC'r blH nnt nn your SI,ltCHwn\. Amount Step 2; Add together checks and other deductions listed in your account register but not on youl'st:ltement. Date of Deposit Total A Step 3: Elller lIlt' ('ndill.~ IXll;mce recorded on your st:1tellleut Add dt'po.~its :1IH] otlH:'r ;JclditiollS Hot recorded Total A + $-1 d I(,d, (pI $ $ _taL~ &, r .$ _--G5.~ 8' 0 $ -5 h5~ 1'8 f Subtotal= Subtract dlL'd,~ ,1tlCl other dl'ductions not recorded T01~11 B ~ TilL' re:-;ult should C<JlI:)! your account regi$ler b<lI<lllCe Ched( Number t)r Amou,>>.,,,,,,, ,A<- Deduction Description '^" Z? ~ I J J)( 7/3oj(:~ ;jl,' ~ '1, //'')/ (, 'd Total B G--5 D3" go Verification of Direct Deposits 1'0 vcrlfy whether :1 direct deposit or other trallsfer to your ;:Iccount has occurred, call us at the 24-hour Ulstomer service telephone lUllnber listed on the llpp!.'l righl sick of lhe first p:1ge of this S!;:JICl11cnL Electronic Funds Transfers In Ci!~l' of ('rror, or Cj\l(,~liom Jbout your dectl"onir tramfen or ifrou need more infumlation :Jbout a h'ansfer, c<l1l m ,H the 24~hO\lr cU~lOIll{'r sen'ire telephone number listed on the upper right ~jd(' uf the finl P;lgC of thh Sl.l\('lUt'nl. Or, if you prt'fl'r, plc,lse wril~' ll~ at: Customer Service, P.O. Box 609, Pittsburgh, PA 15230-0609. lfthere ha pn.,hlem, you mml t:Oll\~lt:t \1; no \;,\cr Ih,IIl flu ddYS after UlC ending cbLe of the fir!>t statement Oil which the error or problem appeared. \,'111 willllt'ed to provide Ull' following information: Your n;1!lK ,1lHl ;\CullInt lllllll!wrt's); ..\ dC'LTipdon uf I[tlc errol" ')1" the lnll\~f~r YL'\.\ ?ore L1Ue~\im~iu;.!. Plca.l' expbiu as dearly as YOll call why }'Olllll't'd more informatioll or why you believe all error was made; Tit.:: dull a)' ;HlH.ll.llll of the sU,pl'cted errur. We will inveHi:~:l1e yom c-ompbint ,md wm c:orn~ct ::iny error promptly. If the in\'esljgation L1.kes longer tlwn 10 business days, we will credit rour ::iCcollnt for tlw amonnt you think is in error.;u Ill:'!l ;.'uu will h;,ve me of the fund; during the time it taJ.;.es us to complete onr investigation. Member FDIC (,:;;)0 Equal Housing Lender - FOAM953A Rro.v.1S\1'E'I,~(1-g . '".,t, .'". ~,.., .,"- ..., .......- SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYlVAN\;"., INH~RITANCE TAX RETUR~I RESIDENT DECEDENT ESTATE OF PA-CKGR; J;;/YI/J1A E. FILE NUMBER ;;).. I - DiiI - 7.3:z Include unreimbuTsed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT {lNC Itcd" post c/.D. d. .,. ?, If" 3'1 " " I' .,: :?:i. 77 " ,. 1/ '!- IK ./(" 1. .:l. &. vC C heel:: C"'l".l Pu.r"hllse - cleared 6( vc Check Co-r~ iPU.ro.l,4St - ,. GIANI PoPl> Cilec"- M ":RtnJ,.~ - ,. 3. TOTAL (Also enter on line 10, Recapitulation) $ "7 If. 3.2- (If more space is needed, insert additional sheets of the same slze) '''''':''.''"'~ " ~ COMMONWEAnH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF fJA-GKGt<) E1fIf/A E. NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. Ei..II/IIE: :;J.;l.;z teED L. SJlliU_ 7n#}: tff)/lf> FILE NUMBER RELATIONSHIP TO DECEDENT Do Not List Trustee(s) V/fUGHrC'7'i? :z. 1- 0.;1 - 7:3 2- AMOUNT OR SHARE OF ESTATE 100 h, ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON. TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 'Bo1t_INv SfttlNGS ~ 1M 17{)07 1. B CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT OF EMMA E. PACKER 21-02-732 I, EMMA E. PACKER, also known as E. E. PACKER, a single woman, currently of 1055 AlIendale Road, Apartment G, Meadowood Apartments, Mechanicsburg, Cumberland County, Pennsylvania, 17055 being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, is to be distributed to my daughter ELAINE L. SHELL. In the event she predeceases me, then all the rest, residue and remainder shall go to to my son-in-law JOHN M. SHELL. In the event he predeceases me, then all the rest, residue and remainder shall go to to my niece ALBERTA MAE ROGERS, per stit:pes. 3. I nominate, constitute and appoint my daughter, ELAINE L. SHELL, to be the Executrix of this my Last Will and Testament. In the event that she is unable or unwilling to act as Executrix, I appoint my son-in-law JOHN M. SHELL to be the Executor in her place and stead. In the event that he is unable or unwilling to act as Executor, I appoint my my niece ALBERT A MAE ROGERS, to so serve as the Executrix in his place and stead. I further direct that they shall not be required to file bond or other security in the Office of the Register of Wills for the purpose of administering my Estate. Il'l WITNESS WHEREOF, I have hereunto set my hand and seal this Cljut.1 , A.D. 2002. M day of ~ c: ~~ (SEAL) EMMAE: PACKER . r" ' , -'3- = ,~..- 4<'/.Je2--' (SEAL) a!k/aI E. E. PACKER Signed, sealed, published and declared by the above-named EMMA E. PACKER, also known as E. E. PACKER, as and for her Last Will and Testament, in the presence of us, who at her request and in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses. /'1/ 1#', CERTIFICATION OF NOTICE UNDER RULE 5.6(al Name of Decedent: Emma E. Packer Date of Death: August 1, 2002 Will No. TO THE REGISTER: Admin. No. 21-02-0732 I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on October 15, 2002: Name Address Elaine L. Shell 222 Red Tank Road, Boiling Springs, PA 17007 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: October 15, 2002 7 ~C ~~~~- CHARLES E. SHIELDS, III ? 6 Clouser Road Mechanicsburg, PA 17055 Telephone: (717) 766-0209 Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA REV-1162 EXI11-961 DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 002324 SHIELDS CHARLES E III 6 CLOUSER ROAD MECHANICSBURG, PA 17055 ACN ASSESSMENT AMOUNT CONTROL NUMBER ________ told __________ ________ ESTATE INFORMATION: ssrv: i72-oi-2412 FILE NUMBER: 2102-0732 DECEDENT NAME: PACKER EMMA E DATE OF PAYMENT: 03/21 /2003 POSTMARK DATE: 00/00/0000 couNTY: CUMBERLAND DATE OF DEATH: 08/01 /2002 101 ~ 5 2, 646.16 TOTAL AMOUNT PAID: REMARKS: CHARLES E SHIELDS III ESQUIRE CHECK#572 INITIALS: AC 52,646.16 SEAL RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS ~~ STATUS REPORT UNDER RULE 6.12 Name o f Decedent : C~/n n? ail. `~~k'F~ Date of Death: ~- ~- C~~- Will No. Admin . No . of ~- ~ ~ - ~.J ~- Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State w ether administration of the estate is complete: Yes No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal re~esentative file a final account with the Court? Yes No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. l~te• Signature ~.., Charles E. Shields, III ~`•' ~ Name (Please type or print) `_- 6 Clouser Road, Mechanicsburg, PA 17055 ~ Address ~ ,,~ (717) 766-0209 -; _~.:~ Tel. No. ~w Capacity: Personal Representative Counsel for personal representative (MAH:rmf/AM3)